Culturally Re-Centering Contingency Management and Behavioral Economics to Increase Engagement with American Indian Young Adults

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Project Summary This Mentored Research Scientist Development (K01) application will provide the candidate with the necessary skills to become an independent investigator focused on the development and implementation of alcohol misuse interventions for American Indian (AI) young adults. The activities in the K01 include utilizing community-based participatory research to culturally re-center a Contingency Management alcohol intervention that combines technology-based engagement strategies and behavioral economic theoretical models to increase retention of AI 18-29 year olds. To support the achievement of career and research goals the candidate has carefully assembled a team of experts in the areas of culturally tailoring substance use disorder treatments among AI people, community-based participatory research, behavioral economics, Contingency Management and technology delivered alcohol interventions among young adults (Drs. Kamilla Venner; Nina Wallerstein; James Murphy; Matthew Pearson; Michael McDonell and J. Scott Tonigan). The candidate’s training goals include: 1) Acquire the content knowledge to develop culturally grounded alcohol use disorder interventions and apply behavioral economic theoretical models with AI communities; 2) Harness technology in the delivery of alcohol use disorder interventions; 3) Strengthen expertise in mixed, methods longitudinal and advance statistical analyses; and 4) Grant writing. In partnership with a rural reservation community, the candidate will implement an enhanced Contingency Management (CM) intervention for at risk drinkers (AUDIT > 8) aged18-29 year old, with a focus on enhancing treatment attendance and engagement in substance free activities. This objective will be achieved in two phases, with Phase I consisting of establishing a Community Advisory Board that will guide the research and assist with conducting four focus groups (n = 8 per group) and twenty semi-structured interviews with young adults, providers and cultural leaders to identify the form and structure of a culturally centered approach to treatment and engagement in CM and substance-free activities. Phase II will involve a 12-week two-group RCT (n = 60) that compares standard CM with the re-centered CM plus. Fixed assessments will occur at baseline and at 4, 8, and 12-weeks and the enhanced CM condition will employ mobile devices to assess substance free activities weeks 10-12. Study aims will address (1) whether rewarding treatment attendance and alcohol abstinence increases retention and abstinence, and (2) assess daily community recovery alternatives and engagement in substance-free activities. As an exploratory analysis, we will also assess secondary outcomes to determine responders and non-responders to the planned intervention. Collectively, career development and research activities are tightly integrated and mutually supportive thus offering an ideal platform for Dr. Hirchak to become an independent investigator.